2014
ANNUAL REPORT
CONTENTS
Foreword
3
Dental Council statement
5
Dental Protection statement
6
Facilitator’s report
7
FOREWORD
AWARENESS BUILDING Since its establishment in 2012, levels of awareness and activity for the DCRS have grown significantly. The Dental Complaints Resolution Service was launched in May 2012 as an alternative means to handling complaints registered following receipt of dental care and treatment within the Republic of Ireland, other than under the scope of the medical card (DTSS) or social insurance (DTBS) schemes. The Service is a voluntary initiative promoted by the Irish Dental Association and is open to complainants and dentists. Being voluntary, no dentist can be compelled to participate. It can be availed of without charge by IDA members while non-members pay a fee of ¤95 per complaint.
IT (THE SERVICE) CAN BE AVAILED OF WITHOUT CHARGE BY IDA MEMBERS WHILE NON-MEMBERS PAY A FEE OF €95 PER COMPLAINT.
At the end of 2014, a review was commenced for consideration by the Board of Directors of the Irish Dental Association and the Council of the Irish Dental Union, with the objective of reviewing the operation of the Dental Complaints Resolution Service and to propose
promote awareness of the Dental Complaints Resolution Service in
recommendations for change and improvement in its operation.
responding to queries received from the general public and from dentists.
The review reflected interviews with a small number of individuals
Among dentists, there is a reasonably strong awareness of the Dental
intimately acquainted with the operation of the Dental Complaints
Complaints Resolution Service. The IDA survey of private practitioners,
Resolution Service, the findings of a survey of private practice dentists
which attracted 192 responses, shows that:
conducted by the Association, and a review of a sample of cases
n 91% of respondents were aware of the Service;
conducted with the kind assistance of two dentists, two DPL
n 80% were aware that this was a service provided by the IDA;
representatives and a senior official from the UK Dental Complaints
n 40% were aware of the Service’s website;
Service. We wish to thank all concerned for their generous and
n 74% were aware that the Dental Council requires dentists to have a
invaluable assistance.
procedure in their practice to handle complaints; n 13% were very or extremely familiar with the operation of the Service
Activity levels
while 60% were not at all or slightly familiar with the operation of
The level of activity for the service has been consistently high. In 2013,
the Service;
the Service received 1,230 letters and 262 telephone calls, arising from
n 97% support the idea of the Service as a worthwhile initiative;
which 130 complaints were received. In 2014, 384 calls and 1,250 emails
n 94% believe that dentists generally support the idea of the Service;
were received, from which 158 complaints emerged.
n 94% would avail of the Service if a patient raised a complaint that
Awareness of the Dental Complaints Resolution Service
n 64% of respondents who availed of the Service (n=33) stated they
could not be resolved directly; The Dental Complaints Resolution Service is promoted primarily through
were very or completely satisfied with the handling of a complaint
its own website (www.dentalcomplaints.ie), through regular mention in
by the service;
the Journal of the Irish Dental Association, through communications to
n 80% of those who availed of the Service claimed they contacted their
dentists by the Association and DPL in particular, and through
defence organisation or representative within ten days of receiving a
intermittent media coverage. The Dental Council and the Association also
complaint;
DCRS | ANNUAL REPORT 2014 3
FOR THE 12 MONTHS TO MARCH 2015, THE WWW.DENTALCOMPAINTS.IE WEBSITE ATTRACTED 17,439 VISITS OR JUST UNDER 60,000 HITS.
n 32% of those who availed of the Service believed the settlement was unfair or very unfair, 32% thought it was about right and 36% thought it was fair or very fair; n 64% were very or completely satisfied with the timeliness of the response and ongoing dialogue with the Service; and, n 60% were very or completely satisfied with the written communications with the Service. For the 12 months to March 2015, the www.dentalcomplaints.ie website attracted 17,439 visits or just under 60,000 hits. We expect that extra resources will be needed to enable the Service to cope with the increasing level of enquiries being received, lessons learned from the first ever review, and also to reflect best practice and good governance. In the meantime, we are pleased to commend the service and to thank all who have contributed to its continued success.
Dr Peter Gannon
4 DCRS | ANNUAL REPORT 2014
Mr Fintan Hourihan
President
Chief Executive Officer
Irish Dental Association
Irish Dental Association
DENTAL COUNCIL STATEMENT
MUTUAL BENEFIT Dr Eamon Croke, President, Dental Council of Ireland, says that successful management of a complaint is liberating. A complaint has been described as “an expression of dissatisfaction
of a complaint while seeking time to consider the complaint – it is
whether justified or not” (BS8600:1999). The majority of complaints
good manners. It is also courteous and sensible to listen to the
received by Dental Council from patients about dentists or dental
complaint in a calm, attentive manner, giving the patient the chance
treatment are broadly consumer type grievances. The types of
to air their grievance and you a chance to understand their situation
complaints received revolve around dissatisfaction with treatment,
before considering your response. It takes time to consider a
communication issues, fees or adverse events. It is unsettling to note
complaint, to appreciate the full picture and to communicate your
that 25% of communication complaints relate to dentists’ behaviour
solution, but this should be done within a specified (short) time
after the patient brought a concern to their attention. All of these
period. Good communication is critical to successful complaint
types of complaints are within the remit of all dental practices to
management. Delivering your solution by phone or face to face can
address and resolve to mutual benefit.
add value to the solution if you have the required communication
There is evidence that complaints in general are rising. Consumer
skills. Training is the safeguard to the prevention and resolution of
protection has become a central concern for governments. As
complaints and should involve all members of the dental team. Keep
consumers we are encouraged to complain if we are dissatisfied. The
clear, comprehensive, contemporaneous records of all complaints.
right to complain is enshrined in consumer laws and encouraged by
Successful management of a complaint is liberating. It allows the
many State agencies. Healthcare provision is now regularly considered
patient and your practice move on from the experience providing the
a service provision with patients portrayed as consumers. Every practice
patient with a positive impression of your practice, and your sense
should already have a protocol in place to manage complaints.
of responsibility to and care for your patients. It allows you and the members of your team to learn from the complaint, helping to avoid
5.4
We expect your practice to have a complaints
similar situations. Clearly, a well-handled complaints procedure limits
procedure on public display which clearly
the stress for all concerned and reduces the time spent on such
outlines how:
matters. It is also cost-effective.
•
to make a complaint, and
I think it is true that most people do not want to complain unless
•
how your practice would deal with it.
compelled to do so. It is within the capacity of all dental practices to
This procedure should identify by name the person who deals with
minimise that risk to the benefit of all.
patients’ complaints. Code of Practice relating to: Professional Behaviour and Ethical Conduct (2012)
There is universal agreement that complaint management has a huge effect on outcome. Successful complaint management requires the 4 Cs: courtesy, consideration, communication and competency.
Dr Eamon D Croke
Courtesy is essential to the prevention and resolution of complaints.
President
It is not an admission of guilt to apologise to a patient upon receipt
Dental Council
DCRS | ANNUAL REPORT 2014 5
DENTAL PROTECTION STATEMENT
SUCCESSFUL FACILITATION IS WELCOME Good communication can help prevent complaints, but when they do arise, the Dental Complaints Resolution Service is providing excellent facilitation. Even in the best dentist-patient relationship, a problem may occur.
of us are aware from recent media coverage that the legal process can
However good a dentist is, and however dedicated a patient may be,
be slow and costly, and very often the outcome does not entirely
there may be times when a complaint or concern can arise.
satisfy the patient as it does not normally include either an explanation
The creation of a sound dentist-patient relationship is the basis for
or an apology. These fundamental issues are often what a patient
good communication. It demonstrates a desire on the part of the
wants most.
dentist and the patient to discuss and agree the course of treatment,
The fact that the DCRS is easy to access, simple to use and often
and the expectations of the outcome can go a long way toward
results in quick resolution, to the satisfaction of both the patient and
establishing a relationship of trust and confidence. Similarly, if a patient
the dentist, is likely to have contributed to its success.
has a concern he or she should let the dentist know as soon as possible;
The DCRS’s Michael Kilcoyne has proved to be an accessible, and
sometimes the dentist may have no idea that there is a problem or
successful, facilitator and the Irish Dental Association’s commitment
concern, and would like the opportunity of investigating the situation
to the service is to be welcomed.
and resolving it as soon as possible.
The DCRS has now been in place for three years and the number of
Even when the dentist has a practice complaints procedure in place,
complaints already resolved is a testament to its success and to the
there can be occasions when a patient may be too embarrassed or
dental profession which has embraced the concept, and the team
reluctant to contact their dentist. In reality, a dentist, like any other
behind the Service itself.
professional, will want to deal with a complaint or a concern professionally and courteously once they become aware of the problem. Past experience has shown that when a complaint is handled well, the professional relationship between the dentist and the patient can still be re-established. A patient who has had their complaint resolved can even go on to be one of the dentist’s greatest supporters. The days are long gone when a complaint was only seen in a negative way.
Dr Sue Boynton
Complaints can be a real opportunity to improve communication, or
Senior Dento-legal Adviser – Head of Dental Services Ireland
to explain some aspect of dental care.
Dental Protection
Certainly, the introduction of the Dental Complaints Resolution Service (DCRS) has increased patient awareness of practice complaints procedures. When a problem or misunderstanding cannot be resolved between a dentist and a patient, the DCRS is there to help. You can see from their annual report that a number of complaints can be resolved with their input.
Dental Protection Limited (registered in England No. 2374160) is a
The alternatives are instructing a solicitor or making a complaint to the
wholly owned subsidiary of The Medical Protection Society Limited,
Dental Council. However, the Dental Council only investigates fitness
which is registered in England (No.36142). Both companies have their
to practice issues rather than straightforward patient complaints. Many
registered office at 33 Cavendish Square, London W1G 0PS.
6 DCRS | ANNUAL REPORT 2014
FACILITATOR’S REPORT
MORE AWARENESS, GREATER ACCEPTANCE In 2014, Michael Kilcoyne, the Facilitator of the Dental Complaints Resolution Service, accepted 158 cases and resolved 36 complaints. He reports that there is now greater awareness of the Service among the public. In 2014, 158 cases were accepted by the Dental Complaints
sufficient experience has been accumulated to allow for a speedier
Resolution Service (DCRS or Service). Many of these were resolved
resolution of routine matters that result in complaints.
directly between the dentist and the patient. A total of 36 complaints
Secondly, there is an increased awareness among the public that this
were resolved through mediation, and 26 of these were resolved by
Service exists to help them to resolve a dispute with their dentist.
a full or part refund of fees to the patient. Three were resolved
While the matter under dispute can be highly significant, or merely
through re-treatment. Two cases were resolved by payment of fees
mundane, the fact that it is under dispute can cause considerable
for further treatment and one case was resolved by an apology. Three
distress to both the patient and the dentist. The availability of the
patients withdrew their complaints, one of whom is believed to be
Service is helping to reduce the difficulty involved in resolving a
pursuing legal proceedings. A further complaint was resolved by the
dispute.
dentist issuing a Med 2 Form to the patient.
Thirdly, there is now a high level of acceptance of the bona fides of
In 2014, 384 calls and 1,259 emails or letters were received by the
the service among the dental profession. This is leading, in turn, to
Service. Out of that contact, 158 cases were accepted. Seven cases
a high level of co-operation with the Service.
were not accepted as they were for treatment provided under the medical card scheme (the DTSS). Of the complaints that were accepted, 64 related to fees, 62 covered clinical matters, and 32
ADVICE TO DENTISTS
related to communications.
The most important advice that the Dental Complaints Resolution
The DCRS is an independent service for patients who have failed to
Service can offer to dentists is to listen closely to their patients.
have a complaint about a dental matter resolved satisfactorily in the
Even if the dentist believes they are not in the wrong, they should
practice where the issue arose. While the Service was established by
address their patient's views. There will always be a certain amount
the Irish Dental Association, it operates entirely independently.
of complaints when you are providing a service, and sometimes
All dentists are required by the Dental Council of Ireland to have a
these can be resolved, or even avoided, simply by communicating.
formal complaints procedure in place for their surgeries. Where a patient has tried to resolve a complaint with a dental practice through its complaints procedure and is still not satisfied, the patient may
ADVICE TO PATIENTS
escalate the complaint to the Service. The dentist must also accept
If you have a complaint against your dentist, you should always
the complaint will be handled by the Service. If a dentist is a member
raise it with the dentist first. Explain the problem calmly and clearly,
of the IDA, the work of the Service is free. A modest fee is charged
and try to resolve the issue. If necessary, seek a second opinion
to non-members to avail of the DCRS.
from another dentist. If the complaint is not resolved satisfactorily, contact the Dental Complaints Resolution Service. In order to deal
Comment
with the case, the Service must receive your complaint in writing,
I wish to make three observations on the operation of the Service in
and once that is received, work will commence on resolving the
2014. Firstly, good progress has been made in the daily workings of
complaint as soon as possible.
the Service. As it has now been in operation since April 2012,
DCRS | ANNUAL REPORT 2014 7
COMPLAINTS RECEIVED FROM
SUBJECT OF COMPLAINTS RECEIVED
JANUARY 1 TO DECEMBER 31, 2014
SINCE JANUARY 1, 2014
Patient contact Number of calls received Number of emails/letters received Number of complaints not accepted, i.e., outside remit, or out of time Number of complaints accepted
384 1,250 7* 158
* Medical Card complaints not accepted
Dentists IDA members
Approximately 65% are members of the IDA
Resolution Time taken from receipt of complaint to resolution
36 cases have been resolved since January 1, 2014. Three patients withdrew.
Brief details of resolution Explanation Apology Re-treatment Refund of fees/part refund Payment of fees for remedial treatment Unable to resolve
1 Med 2 Form issued 1 3 26 2 3**
** patients withdrew (one to solicitor )
Type of complaint Fees Clinical Communication
64 62 32
Treatment Diagnosis Fillings Denture Crown/bridge Root canal Orthodontic Oral surgery – extractions Implants Scale and polish Infection control Non-treatment Failure of treatment Postoperative pain Pain during treatment Failure to address pain Failure to explain treatment costs Failure to explain treatment details Treatment plan not followed No or inadequate treatment plan Refusal to treat Problems with continuing care Consent not given Rudeness Failure to address complaint Other – cost
OUTLIER IN PATTERN OF COMPLAINTS In the experience of the Facilitator, 85% of the complaints he accepts are single complaints about a dental practice. He occasionally gets two complaints arising from a practice but has experience of only one practice against which three complaints have been made – all of which he considers relatively minor matters. Therefore, his experience of having one practice having six complaints of a serious nature accepted for investigation over a period of 18 months is a matter of concern to him. He is of the opinion that there are items likely to be included in the forthcoming Dental Bill, which, when enacted, would allow for strong action to being taken against such a practice by the Dental Council of
Michael Kilcoyne
Ireland.
Dental Complaints Resolution Service
8 DCRS | ANNUAL REPORT 2014
3 12 5 9 9 5 7 2 1
4 7 1 3 7 9 2 4 2 4 2 2 16 52
9 Turlough Road Castlebar Co. Mayo
Unit 2, Leopardstown Office Park Sandyford Dublin 18
Tel: 094 902 5105 Email: michael@dentalcomplaints.ie
Tel: 01 295 0072 Email: info@irishdentalassoc.ie
www.dentalcomplaints.ie
www.dentist.ie